Provider First Line Business Practice Location Address:
9393 TOWNE CENTRE DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-3070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-964-5004
Provider Business Practice Location Address Fax Number:
858-362-1051
Provider Enumeration Date:
04/16/2012